Rates of heterosexually transmitted HIV infection among African Americans in the southeastern United States greatly exceed those for whites.
Determine risk factors for heterosexually transmitted HIV infection among African Americans.
Population-based case-control study of black men and women, aged 18-61 years, reported to the North Carolina state health department with a recent diagnosis of heterosexually transmitted HIV infection and age- and gender-matched controls randomly selected from the state driver s license file. A lower-risk stratum of respondents was created to identify transmission risks among people who denied high-risk behaviors.
Most case subjects reported annual household income <$16,000, history of sexually transmitted diseases, and high-risk behaviors, including crack cocaine use and sex partners who injected drugs or used crack cocaine. However, 27% of case subjects (and 69% of control subjects) denied high-risk sexual partners or behavior. Risk factors for HIV infection in this subset of participants were less than high school education (adjusted odds ratio [OR] 5.0; 95% CI: 2.2, 11.1), recent concern about having enough food for themselves or their family (OR 3.7; 1.5, 8.9), and having a sexual partner who was not monogamous during the relationship with the respondent (OR 2.9; 1.3, 6.4).
Although most heterosexually transmitted HIV infection among African Americans in the South is associated with established high-risk characteristics, poverty may be an underlying determinant of these behaviors and a contributor to infection risk even in people who do not have high-risk behaviors.
From the *Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC; †Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, NC; ‡Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC; §National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and ∥Community Research Group, Columbia University School of Public Health, New York, NY.
Received for publication January 6, 2005; accepted October 10, 2005.
Supported by National Institutes of Health grant 1R01 AI 39176-01 and 1K02 AI01867-01 (to A. A. A.)
Reprints: Adaora A. Adimora, Division of Infectious Diseases, 130 Mason Farm Road, CB #7030, Bioinformatics Building, UNC School of Medicine, Chapel Hill, NC 27599-7030 (e-mail: firstname.lastname@example.org).